Physician documentation of access to firearms in suicidal patients in the emergency department

Introduction: Suicide is the 10th leading cause of death in the United States. An estimated 50% of these deaths are due to firearms. Suicidal ideation (SI) is a common complaint presenting to the emergency department (ED). Despite these facts, provider documentation on access to lethal means is lacking. Our primary aim was to quantify documentation of access to firearms in patients presenting to the ED with a chief complaint of SI.Methods: This was a cross-sectional study of consecutive patients, nearly all of whom presented to an academic, urban ED with SI during July 2014. We collected data from all provider documentation in the electronic health record. Primary outcome assessed was whether the emergency physician (EP) team documented access to firearms. Secondary outcomes included demographic information, preexisting psychiatric diagnoses, and disposition.Results: We reviewed 100 patient charts. The median age of patients was 38 years. The majority of patients had a psychiatric condition. EPs documented access to firearms in only 3% of patient charts.Conclusion: EPs do not adequately document access to firearms in patients with SI. There is a clear need for educational initiatives regarding risk-factor assessment and counseling against lethal means in this patient cohort

Effigy Vessel Documentation, Caddo Collections at the Texas Archeological Research Laboratory at The University of Texas at Austin

Ceramic vessels from ancestral Caddo sites in East Texas are diverse in form, size, manufacture, and decoration, both spatially and temporally. Variation in these attributes, including vessel form as well as any attachments, also “is connected with particular local and regional traditions” (Brown 1996:335). To both appreciate and understand the meaning of vessel form diversity in Caddo vessel assemblages in East Texas—or any other part of the much larger southern Caddo area—the consistent identification of different vessel forms and vessel shapes is crucial. The formal identification of the diverse vessel forms and vessel shapes, in conjunction with other vessel attributes, most notably decorative motifs and elements, present in Caddo vessel assemblages should contribute to delimiting the existence and spatial distribution of communities of Caddo potters that were sharing or not sharing ceramic practices and traditions in both short-term and long-term spatial scales, and illuminating small or expansive networks of social groups tied together through regional interaction. In this study, the focus is on ceramic effigy vessels from Caddo sites in East Texas that are in the collections at the Texas Archeological Research Laboratory at The University of Texas at Austin (TARL). Ceramic effigy vessels are a very rare vessel form found on Caddo sites, as they comprise about 1 percent of the more than 3100 Caddo vessels currently in the TARL collections. Three different effigy bowl shapes have been identified in East Texas Caddo vessel assemblages. The differences primarily resolve around the character of the effigy head (both bird and abstract forms) as well as the nature of any other appendages, such as tab tails and tail riders. The effigy bowls themselves are simple in form, with rounded body wall contours

Analyzing Medication Documentation in Electronic Health Records: Dental Students’ Self-Reported Behaviors and Charting Practices

The aim of this two-part study was to assess third- and fourth-year dental students’ perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients’ medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents’ most frequently cited perceived barriers to medication documentation were patients’ not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low

Impact of Scribes with Flow Coordination Duties on Throughput in an Academic Emergency Department

Introduction: With the increasing influence of electronic health records in emergency medicine came concerns of decreasing operational efficiencies. Particularly worrisome was increasing patient length of stay (LOS). Medical scribes were identified to be in a good position to quickly address barriers to treatment delivery and patient flow. The objective of this study was to investigate patient LOS in the mid- and low-acuity zones of an academic emergency department (ED) with and without medical scribes.Methods: A retrospective cohort study compared patient volume and average LOS between a cohort without scribes and a cohort after the implementation of a scribe-flow coordinator program. Patients were triaged to the mid-acuity Vertical Zone (primarily Emergency Severity Index [ESI] 3) or low-acuity Fast Track (primarily ESI 4 and 5) at a tertiary academic ED. Patients were stratified by treatment zone, acuity level, and disposition.Results: The pre-intervention and post-intervention periods included 8900 patients and 9935 patients, respectively. LOS for patients discharged from the Vertical Zone decreased by 12 minutes from 235 to 223 minutes (p<0.0001, 95% confidence interval [CI], -17,-7) despite a 10% increase in patient volume. For patients admitted from the Vertical Zone, volume increased 13% and LOS remained almost the same, increasing from 225 to 228 minutes (p=0.532, 95% CI, -6,12). For patients discharged from the Fast Track, volume increased 14% and LOS increased six minutes, from 89 to 95 minutes (p<0.0001, 95% CI, 4,9). Predictably, only 1% of Fast Track patients were admitted.Conclusion: Despite substantially increased volume, the use of scribes as patient flow facilitators in the mid-acuity zone was associated with decreased LOS. In the low-acuity zone, scribes were not shown to be as effective, perhaps because rapid patient turnover required them to focus on documentation

Caddo Vessels from the Susie Slade Site (41HS13), Harrison County, Texas

The Susie Slade site (41HS13) is an ancestral Nadaco Caddo settlement and cemetery on a sandy knoll in the Potters Creek valley in the Sabine River basin. The site is known to have had a large cemetery (\u3e 90 burials) that was excavated by a number of East Texas collectors and amateur archaeologists in 1962, University of Texas (UT) archaeologists; one burial reportedly had 36 stacked Simms Engraved vessels as funerary offerings. Ceramic vessels from the UT investigations at the Susie Slade site are in the collections of the Texas Archeological Research Laboratory (TARL), along with vessels donated to TARL by Forrest Murphey, one of the amateur archaeologists that worked at the site. These vessels are documented in this article, following the standard protocol for vessel documentation in use for several years in the analysis of Caddo ceramic vessels from East Texas sites

Special Libraries, December 1964

Volume 55, Issue 10https://scholarworks.sjsu.edu/sla_sl_1964/1009/thumbnail.jp

Special Libraries, December 1964

Volume 55, Issue 10https://scholarworks.sjsu.edu/sla_sl_1964/1009/thumbnail.jp

Three dimensional asset documentation using terrestrial laser scanner technology

Asset documentation is a detailed record or inventory of the properties located within a room or a building. It is important to record the assets in case of property loss happen inside the premise especially when that premise caught fire, earthquake, robbery and others. The instrument used in this study is Faro Laser Scanner Photon 120/20. The object of the study is the computer room of Photogrammetry Lab, Faculty of Geoinformation and Real Estate. The final output of this study is the 3D model of the assets available inside the building. Before 3D model can be formed, the scanned data which is in the form of point cloud generated from the laser scanner have to be registered and georeferenced in order to combine the scans. The combine scans is the representation of the whole area of work surveyed from every scan points. These processes use Faro Scene, software that comes together with the laser scanner. By introducing this method, large scale asset documentation such as for factories and schools would be very beneficial rather than conventional method. The next process is to model the point cloud using AutoCAD 2011. Every item available on the room such as desks, chairs, cubicles, computers, whiteboard, projectors and cupboard are modeled and each of these items was inserted with attributes so that we can know the information of each item

Information Overload: An Overview

For almost as long as there has been recorded information, there has been a perception that humanity has been overloaded by it. Concerns about 'too much to read' have been expressed for many centuries, and made more urgent since the arrival of ubiquitous digital information in the late twentieth century. The historical perspective is a necessary corrective to the often, and wrongly, held view that it is associated solely with the modern digital information environment, and with social media in particular. However, as society fully experiences Floridi's Fourth Revolution, and moves into hyper-history (with society dependent on, and defined by, information and communication technologies) and the infosphere (a information environment distinguished by a seamless blend of online and offline information actvity), individuals and societies are dependent on, and formed by, information in an unprecedented way, information overload needs to be taken more seriously than ever. Overload has been claimed to be both the major issue of our time, and a complete non-issue. It has been cited as an important factor in, inter alia, science, medicine, education, politics, governance, business and marketing, planning for smart cities, access to news, personal data tracking, home life, use of social media, and online shopping, and has even influenced literature The information overload phenomenon has been known by many different names, including: information overabundance, infobesity, infoglut, data smog, information pollution, information fatigue, social media fatigue, social media overload, information anxiety, library anxiety, infostress, infoxication, reading overload, communication overload, cognitive overload, information violence, and information assault. There is no single generally accepted definition, but it can best be understood as that situation which arises when there is so much relevant and potentially useful information available that it becomes a hindrance rather than a help. Its essential nature has not changed with changing technology, though its causes and proposed solutions have changed much. The best ways of avoiding overload, individually and socially, appear to lie in a variety of coping strategies, such as filtering, withdrawing, queuing, and 'satisficing'. Better design of information systems, effective personal information management, and the promotion of digital and media literacies, also have a part to play. Overload may perhaps best be overcome by seeking a mindful balance in consuming information, and in finding understanding